Why adult ADHD is often mistaken for anxiety, and NI's service picture

> Editorial note, 5 August 2026. An earlier version of this article was built around one individual's account. We could not verify that account against a reachable primary source, so it has been removed. This version is a general guide for adults in Northern Ireland and the wider UK, based only on published research and official Northern Ireland Department of Health material.

Many adults are told they have anxiety or depression long before anyone considers ADHD. This isn't necessarily a mistake by any one clinician; ADHD genuinely overlaps with several other conditions, and many adults with ADHD also have a diagnosable anxiety condition alongside it. This article looks at what the evidence says about that overlap, why comorbidity is not the same thing as misdiagnosis, and the specific service picture for adults seeking an ADHD assessment in Northern Ireland.

Why ADHD and anxiety get confused

According to BJPsych Advances, in an article on the misdiagnosis and missed diagnosis of adult ADHD, ADHD symptoms overlap with anxiety, depression, bipolar disorder and personality disorder. Restlessness, difficulty concentrating, irritability and sleep disturbance, all common features of anxiety, can also be features of ADHD, and the two can look very similar from the outside, and even from the inside, particularly if someone has spent years managing undiagnosed ADHD in a way that has produced genuine anxiety as a consequence.

The same BJPsych Advances article reports that 75% of adults with ADHD have at least one other psychiatric diagnosis. This is an important and precise figure, and it needs to be read carefully: it does not mean 75% of people are wrongly diagnosed. It means that among adults who do have ADHD, having at least one other genuine psychiatric condition alongside it (comorbidity) is the norm rather than the exception. The article notes that this symptom overlap can result in an incorrect diagnosis being made, which is a distinct issue from comorbidity itself.

Comorbidity is not the same as misdiagnosis

It is worth separating two different situations clearly, because they are often blurred in everyday conversation:

• Comorbidity means a person genuinely has two or more conditions at the same time, for example ADHD and an anxiety disorder, both present and both real.
• Misdiagnosis means a person is given one diagnosis (such as anxiety) when the more accurate or more complete explanation for their difficulties was ADHD, either instead of or in addition to anxiety.

The BJPsych Advances article discusses both: it explains that comorbidity is common in adult ADHD, and separately, that the overlap in symptoms between ADHD and other conditions such as anxiety can result in an incorrect diagnosis being made, meaning ADHD is missed or is not the diagnosis first reached. These are related concepts but not identical ones, and only a qualified clinician carrying out a full assessment can work out which situation applies to any individual.

What NICE guidance says about assessment

NICE guideline NG87 sets out that a thorough ADHD assessment for adults should consider differential diagnosis (ruling in or out other conditions that could explain the same symptoms) and should take existing or possible comorbidities into account, rather than assuming that a single label explains everything. This is precisely the kind of process needed to work through the overlap between ADHD and anxiety described in the BJPsych Advances article. It is important to note that NICE guidance is adopted differently across the UK's four nations, and Northern Ireland has its own service arrangements, discussed below.

The Northern Ireland picture

Adults in Northern Ireland face a specific and separately documented service context. BBC News NI reported on 2 April 2023 that the situation for adults waiting for an ADHD diagnosis in Northern Ireland was described as "dire". This reporting predates more recent developments, but it establishes that pressure on NI's adult ADHD assessment pathway has been a recognised, publicly reported issue for some time.

More recently, Northern Ireland's Department of Health published the Attention Deficit Hyperactivity Disorder (ADHD) Needs Assessment final report on 12 February 2026. This report documents ADHD service provision for children, young people and adults across Northern Ireland, giving a more detailed and current picture of how services are organised and where gaps exist than was available at the time of the 2023 BBC News NI report.

Why this matters for the anxiety-versus-ADHD overlap

Where assessment services are under significant pressure, as both the 2023 BBC News NI report and the wider context around the 2026 Needs Assessment report suggest has been the case in Northern Ireland, there is more scope for adults to be seen first, or only, by services oriented around more commonly diagnosed conditions such as anxiety or depression, simply because those pathways may be more readily available. This does not mean every anxiety diagnosis given to someone who later turns out to have ADHD was wrong; as the BJPsych Advances article makes clear, many people genuinely have both. But service pressure can plausibly extend how long it takes for the fuller picture, including possible ADHD, to be properly assessed.

What adults in Northern Ireland can do

• If you have an anxiety or depression diagnosis but continue to experience longstanding difficulties with attention, organisation or impulsivity that predate your current symptoms, mention this clearly to your GP and ask whether an ADHD assessment referral is appropriate.
• Check the Northern Ireland Department of Health's published materials, including the February 2026 ADHD Needs Assessment final report, and your local Health and Social Care (HSC) trust, for the current referral pathway, since arrangements can change and can differ from those in England, Scotland or Wales.
• Be aware that NICE guideline NG87 is the guideline most commonly referenced for ADHD assessment good practice across the UK, but Northern Ireland's own service arrangements, as set out by the Department of Health, determine how and where you can access an assessment locally.
• Remember that only a qualified clinician carrying out a full assessment can determine whether you have ADHD, an anxiety disorder, both, or neither. This article cannot and does not offer a diagnosis.

A general explainer, not a personal account

This article is written as a general explainer for adults in Northern Ireland and the wider UK navigating the overlap between ADHD and anxiety, based only on the sources referenced. It does not describe or draw on any individual's personal story or diagnostic journey.

ADHD Tribe offers non-clinical coaching for adults with an ADHD diagnosis, or who are exploring whether they may have ADHD. We do not diagnose, treat or offer clinical advice on anxiety or ADHD; if you have concerns, please speak to your GP or local HSC trust.

The wider UK service context

While this article focuses on Northern Ireland, the pressures described in both the 2023 BBC News NI report and the February 2026 Needs Assessment final report are not unique to one part of the UK. Long waits for adult ADHD assessment have been reported across the UK's health systems, and NICE guideline NG87 remains the most widely referenced clinical framework for how those assessments should be structured, wherever in the UK they take place. What differs between nations is how services are commissioned and organised locally, which is why the Northern Ireland Department of Health's own published material, rather than NHS England data, is the right reference point for anyone seeking care in Northern Ireland specifically.

Questions worth raising with a GP

Adults who feel their anxiety diagnosis may not fully explain their experience could consider raising some of the following points during a GP appointment, without expecting the GP to make an ADHD diagnosis on the spot:

• Whether attention, organisation or impulsivity difficulties were present from childhood, since ADHD is a neurodevelopmental condition with an onset before adulthood, even if it is recognised later in life.
• Whether anxiety symptoms improve or worsen depending on structure, deadlines or level of stimulation, which can sometimes point towards an underlying attention-related pattern worth exploring further.
• Whether a referral for a specialist ADHD assessment, in line with NICE guideline NG87, is appropriate alongside or instead of continued anxiety-focused treatment.

These are prompts for a conversation with a qualified clinician, not a checklist for self-diagnosis. Only a full clinical assessment, carried out via the referral pathway available in Northern Ireland's HSC system, can establish what is actually going on for any individual.

References

• BJPsych Advances, Misdiagnosis and missed diagnosis of adult attention-deficit hyperactivity disorder
• Northern Ireland Department of Health, ADHD Needs Assessment final report, 12 February 2026
• NICE guideline NG87, Attention deficit hyperactivity disorder: diagnosis and management
• BBC News NI, "dire" situation for adults waiting for ADHD diagnosis in Northern Ireland, 2 April 2023